License Requirements for Psychiatric Health …

License Requirements for Psychiatric Health

Facilities (PHFs)

ARTICLE 3 SERVICES

77059. Basic Services

The facility may provide services to patients either directly or by written agreement with outside resources as

specified in Section 77109.

77061. Staffing

The facility shall have a clinical director who shall be a licensed mental health professional and qualified in

accordance with section 77093 of these regulations.

The clinical director may also serve as the administrator. The clinical director shall designate a clinical

psychologist or psychiatrist to review and approve interdisciplinary treatment plans.

A physician shall be on-call at all times for the provision of physical health care and those services which can

only be provided by a physician. The person in charge of patient care services on each shift shall be provided

with the names(s) and means of locating and contacting the available physician. Patients requiring general

acute physical health care shall be diverted from admission or transferred to a general acute care hospital.

A prospective patient may be admitted to a psychiatric health facility if the patient's medical condition could

ordinarily be managed on an outpatient basis. by a reasonably competent individual.

If the clinical director is not a physician, responsibility for those aspects of an individual treatment plan which

may only be performed by a physician., shall be assumed by a physician.

During the absence of any staff required in subsection (h)(1) below there shall be a substitute person with the

required qualifications to provide the number of hours of services required.

Community practitioners who are approved to admit and/or attend patients in the facility may be calculated as

part of the staffing pattern only if they are retained by written contract to provide services for a specified number

of hours to the patients at the facility.

Each facility shall meet the following full-time equivalent staff to census ratio, in a 24 hour period:

In patient Census:

1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

Licensed 1 2 3 4 5 6 7 8 9 10

Mental Health Professional

Nursing Staff 4 5 6 8 10 12 14 16 18 20

Mental Health 3 5 8 10 13 15 18 20 23 25

Worker

Totals 8 12 17 22 28 33 39 44 50 55

Weekend and holiday staffing must include adequate nursing and professional staff to provide coverage for the

unit, arrange admissions and discharges, attend rounds and patient activities as necessary at each PHF, but

not necessarily at the same level as on weekdays.

For facilities in excess of 100 beds, staffing shall be provided in the ratios as in (1) above.

A registered nurse shall be employed 40 hours per week.

The registered nurse time may count as part of the total requirement for licensed nursing personnel.

There shall be a registered nurse, a licensed vocational nurse, or a psychiatric technician awake and on duty in

the facility at all times.

The required staffing ratio shall be calculated based upon the inpatient census and shall provide services only

to psychiatric health facility patients.

Regardless of the minimum staffing required in subsection (h)(1) above, the facility shall employ professional

and other staff on all shifts in the number and with the qualifications to provide the necessary services for those

patients admitted for care.

77063. Psychiatric, Psychological and Counseling

Psychiatric services shall be provided by licensed physicians with training and/or experience in psychiatry.

Psychological services shall be provided by clinical psychologists in accordance with Business and Professions

code, Section 2903 and Health and Safety Code, Section 1316.5.

Counseling services shall be provided by licensed clinical social workers in accordance with Business and

Professions Code, Sections 4996 and 4996.9 or licensed marriage, family and child counselors in accordance

with Business and Professions Code, Sections 4980 and 4980.02.

Counseling services may be provided by staff not included in the above cited sections. All counseling services

will be limited by the authority to treat or diagnose as provided by the individual's expertise, certification or

licensure.

77065. Psychiatric Nursing Services

Psychiatric nursing services shall be designed to meet the objectives of each patient's interdisciplinary

treatment plan.

Policies and procedures for the administration of medications shall be implemented by the psychiatric nursing

service.

Nursing services shall include the development of a nursing care plan based upon an initial written and

continuing assessment with input from health professionals involved in the care of the patient. Initial

assessments shall commence at the time of admission of the patient and be completed with 72 hours after

admission.

Nursing care plans may be included as a part of the interdisciplinary treatment plan or may occupy a unique

section of the patient record.

Written nursing services policies and procedures shall be developed which include:

A current nursing procedure manual appropriate to the patient served

by the facility.

Provision for the inventory and identification of patients' personal

possessions, equipment and valuables.

Screening of all patients for tuberculosis upon admission. A tuberculosis screening procedure may not be

required if there is satisfactory written evidence available that a tuberculosis screening procedure has been

completed with 90 days of the date of admission to the facility. Subsequent tuberculosis screening procedures

shall be determined by a physician.

Notification of practitioner regarding sudden or marked adverse change in a patient's condition.

Conditions under which restraints are used, the application of restraints, and the mechanism used for

monitoring and controlling their use.

A planned and systematic process for the monitoring and evaluation of the quality and appropriateness of

patient care and for resolving identified problems.

Psychiatric nursing policies and procedures may be integrated into a single manual with general services which

set forth all policies and procedures for the various functions of the facility. If the policies and procedures are

contained in a general manual, a separate section must be devoted to nursing policies and procedures.

There shall be a written staffing pattern which shall show:

Total numbers of staff including full-time and full-time equivalents.

The available nursing care hours for each nursing unit.

The categories of staff available for patient care.

The psychiatric nursing service shall be under the direction of a registered nurse who shall meet at least the

following qualifications:

Master's degree in psychiatric nursing or related field with experience in

administration

Baccalaureate degree in nursing or related field with experience in

psychiatric nursing and two years of experience in nursing

administration

Four years of experience in nursing administration or supervision and

with experience in psychiatric nursing.

The provisions of this subsection are not intended to require that nursing services be organized as a

department under the guidelines of the "Director of Nurses." Nursing services are to be integrated into the

psychiatric health facility interdisciplinary model.

Psychiatric health facility policies and procedures must specify how a registered nurse will exercise authority

and carry out the responsibility of supervising nursing activities such as, but not limited to pouring, dispensing,

and recording of medication(s); the documentation of patient's nursing care needs in the interdisciplinary

treatment plan; the implementation of nursing procedures; the provision of inservice education related to

nursing activities.

77067. Social Services

Social services shall be designed to meet the objectives of each patient's interdisciplinary treatment plan in

accordance with established policies and procedures.

Social services shall be organized, directed and supervised by a licensed clinical social worker.

This section does not require that a Licensed Clinical Social Worker (LCSW) directly carry out social service

functions. The facility may contract, for no less than 4 hours monthly, with a LCSW to periodically monitor and

supervise social services.

77069. Rehabilitation Services

Rehabilitation services mean those activities provided by occupational therapists, physical therapists or

recreation therapists under the general direction of the clinical director to restore, establish and maintain

optimum levels of social, vocational and physical functioning and to minimize residual disabilities of patients.

Rehabilitation services provided in a psychiatric health facility are to be designed to meet the needs of acute

psychiatric inpatients. Because PHF stays are generally quite brief, the need for traditional rehabilitation

services is limited.

In accordance with established policies and procedures, the scope of these activities shall include at least the

following:

Social activities which involve group participation.

Recreational activities, both indoor and outdoor.

Opportunity to participate in activities outside of the facility if

appropriate.

Exercises.

A physician shall prescribe in the health record the level of physical

activity in which a patient may engage.

77071. Aftercare Services

Prior to or at the time of discharge, each patient shall be evaluated concerning the patient's need for aftercare

services with the result of that evaluation noted in the patient's health record.

Aftercare services are those services to, and on behalf of, a patient following discharge from the psychiatric

health facility for the purpose of enabling the patient to achieve an optimum level of functioning.

Aftercare services shall include but not be limited to the following:

Arranging for out of home placement if necessary.

Arranging for medication supervision if indicated.

Obtaining community social, vocational and educational services if

appropriate.

If a licensed psychiatric health facility does not provide its own aftercare service through its employed staff, it

shall affiliate or have an agreement with a recognized aftercare agency in the facility's service area to provide

aftercare services to patients who could benefit from such services upon discharge from the facility.

A member of the interdisciplinary team designated by the clinical director, shall be responsible for ensuring that

the referral of,the patient to the appropriate aftercare service has been completed and documented in the

patient's health record.

In accordance with Health and Safety Code, Section 1284 and Welfare and Institutions Code, Section 5622,

Aftercare plans shall be transmitted to the local director of mental health services in the county of residence for

any patient placed in the facility under a county Short-Doyle plan.

The local director of mental health services may designate an alternative site as to where the aftercare plan is

to be transmitted and filed.

The content of the aftercare plan shall conform to the requirements of Welfare and Institutions Code, Section

5622.

77073. Interdisciplinary Treatment Plan

A written interdisciplinary treatment plan shall be developed and implemented by the interdisciplinary treatment

team for each patient as soon as possible after admission but no longer than 72 hours following the patient's

admission, Saturdays, Sundays and holidays excepted.

The interdisciplinary treatment plan shall include as a minimum:

A statement of the patient's physical and mental condition, including all

diagnoses.

Specific goals of treatment with interventions and actions, and

observable, measurable objectives.

Methods to be utilized, the frequency for conducting each treatment

method and the person(s) or discipline(s) responsible for each

treatment method.

The interdisciplinary treatment plan shall be reviewed and modified as frequently as the patient's condition

warrants, but at least weekly.

This section requires the interdisciplinary treatment plan (ITP) to be actively used as the instrument for setting

the plan for treating a given patient. Short and long-term goals should be well thought out and reasonable in

light of patient diagnosis, anticipated length of stay, treatment requirements and the economic and social

environment available to the patient upon discharge.

77075. Transfer Summary

A transfer summary shall accompany the patient upon transfer to another health facility. The transfer summary

shall include information relative to the patient's diagnosis, known residual behaviors or symptoms of mental

disorder, medications, treatments, dietary requirements, rehabilitation potential, and known allergies and shall

be signed by the clinical director or the clinical director's designee as specified in Section 77061 ?.

77077. Dietetic Services

The total daily diet for patients shall be of the quality and in the quantity necessary to meet the needs of the

patients and shall meet the "Recommended Dietary Allowances," 9th edition, 1980, or most current edition,

adopted by the Food and Nutrition Board of the National Research council of the National Academy of Science,

adjusted to the age, activity and environment of the group involved. All food shall be of good quality and be

selected, stored, prepared and served in a safe and healthful manner. The following shall apply:

Arrangements shall be made so that each patient has available at least three meals per day. not more than

fourteen (14) hours shall elapse between the third and first meal. A facility may choose to purchase, store and

prepare the required food for its patients, or it may choose to purchase prepared meals from other appropriate

sources, through a written contract.

When a non-inpatient program exceeds four hours, nourishment or snacks shall be available.

A person shall be designated by the administrator to be responsible for the management and operation of the

food service.

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